Korean J Intern Med.  2015 May;30(3):362-371. 10.3904/kjim.2015.30.3.362.

Role of frontline autologous stem cell transplantation in young, high-risk diffuse large B-cell lymphoma patients

• Yoon JH
• Kim JW
• Jeon YW
• Lee SE
• Eom KS
• Kim YJ
• Lee S
• Kim HJ
• Min CK
• Lee JW
• Min WS
• Park CW
• Cho SG

• KMID: 2160709
• DOI: http://doi.org/10.3904/kjim.2015.30.3.362

Abstract

BACKGROUND/AIMS
Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT.
METHODS
We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score > or = 2. From 2006 to 2011, among the 150 DLBCL patients aged < or = 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients.
RESULTS
DLBCL patients with an aaIPI score > or = 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone.
CONCLUSIONS
We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.

Keyword

Lymphoma; Lymphoma, large B-cell, diffuse; Autologous hematopoietic cell transplantation

MeSH Terms

Adolescent
Adult
Age Factors
Antibodies, Monoclonal, Murine-Derived/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Biomarkers, Tumor/blood
Chemotherapy, Adjuvant
Cyclophosphamide/therapeutic use
Disease Progression
Disease-Free Survival
Doxorubicin/therapeutic use
Female
Humans
Kaplan-Meier Estimate
L-Lactate Dehydrogenase/blood
Lymphoma, Large B-Cell, Diffuse/blood/mortality/pathology/*surgery
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Predictive Value of Tests
Prednisone/therapeutic use
Proportional Hazards Models
Reproducibility of Results
Risk Assessment
Risk Factors
*Stem Cell Transplantation
Time Factors
Transplantation, Autologous
Treatment Outcome
Up-Regulation
Vincristine/therapeutic use
Young Adult
Antibodies, Monoclonal, Murine-Derived
Biomarkers, Tumor
Cyclophosphamide
Doxorubicin
L-Lactate Dehydrogenase
Prednisone
Vincristine